Dokument

Summary:
Patient-centered care is a new treatment approach for chronic conditions. Based on patients’ personal experience with a condition it aims at empowering patients to become active partners in health care. The positive effect of patient-centered care on health outcomes is well-established for several chronic diseases. In 2012 the American College of Cardiology highlighted the role of patient-centered care and strongly emphasized the clinical implementation of a patient-centered cardiology. Although psychological approaches could enhance the outcomes of a patient-centered cardiology they have not been considered yet. Psychological approaches could capture patients’ perception of symptoms, cardiac diseases and treatment needs, and thus, provide a basis for an effective patient-centered cardiology. The present dissertation is based on three studies that investigated the perspective of patients with cardiac diseases on symptom, disease, and treatment level. The first study addresses patients’ perceived symptom level and investigates subjective somatic symptom burden in patients with coronary heart disease. Results indicate that somatic symptoms are frequent and burdensome with a wide spectrum. Rather than cardiac symptoms, pain and energy loss are most frequent. Over and above cardiac markers, psychological factors (i.e. depression and anxiety) predict somatic symptom burden. Moreover, as the overall somatic symptom severity largely contributes to a decreased quality of life, the wide spectrum of somatic symptoms (i.e. energy loss) needs to be targeted in clinical routine. The second study focuses patient’s perceived disease level and examines whether patients at risk for decline in health status can be identified before heart valve replacement surgery by profiling their illness perceptions. Results show that patients can be grouped according to the nature and value of illness perception profiles (stable vs. changing; negative vs. positive). Moreover, pre-operative illness perception profiles predict cardiac health status and quality of life one year after heart valve replacement surgery. As follows, patients at risk for decline in health status could be detected before surgery by assessing their illness perception profiles. The third study targets patients’ perceived treatment level. To date, it is the first investigation of supportive care needs in patients with cardiovascular disorders. Results indicate that needs concerning health information and psychological support are frequent unmet supportive care needs. Rather than the cardiac risk profile, patients’ experience with the treatment (i.e. emergency referral, surgery, medication), mood state (i.e. depression and anxiety), and quality of life are associated with supportive care needs. Interestingly, patients who have been in psychotherapy report fewer unmet health needs. An effective treatment of cardiovascular disorders should not only be based on patients’ cardiac risk profile but should also incorporate the subjective need for help on health information and psychological issues. Based on the results of three studies, the present dissertation highlights the importance of incorporating psychological approaches into a patient-centered cardiology. In terms of clinical applications, assessing patients’ perspective on symptom, disease and treatment level with psychological questionnaires could enhance a patient-centered cardiology. Patient-centered cardiology is defined as an evidence-based model of practice. As follows, further research is needed to validate the implementation of the investigated psychological approaches in clinical practice.

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